Acute acalculous cholecystitis as a rare manifestation of chronic mesenteric ischemia. A case report

• Acute acalculous cholecystitis can present de novo in an outpatient setting without any major illness or associated trauma and aortic occlusive disease may represent the most relevant etiological factor in these patients.
• In the settings of chronic mesenteric ischemia, acute acalculous cholecystitis may be interpreted as a herald sign of critical ischemia and mesenteric infarction as a consequence of an acute-on-chronic mesenteric ischemia.
• In our patient, the decision was taken to proceed with immediate mesenteric revascularization simultaneously with the cholecystectomy in order to minimize the risk and extension of a possible bowel infarct.

IntroductionSymptomatic chronic mesenteric ischemia (CMI) is an uncommon condition that usually presents with intestinal angina, sitophobia and unintentional weight loss. Acute acalculous cholecystitis (AAC) has very rarely been described in the settings of CMI.Presentation of caseWe describe a case of a 73 year old man that developed an AAC as a complication of CMI. The patient underwent a simultaneous cholecystectomy and open aortic revascularization which was successful. At 24 months of follow-up the patient is clinically well and regained weight.DiscussionIschemia has been considered an important etiology for the development of AAC. In the settings of CMI, an AAC might develop has a herald sign of progression to acute mesenteric ischemia and infarction, as the cystic artery is a terminal artery with no collateral network. Performing the aortic revascularization simultaneously with the cholecystectomy might prevent this possible fatal outcome.ConclusionThis case reinforces aortic and visceral occlusive disease as a possible risk factor for the development of AAC, and discusses the treatment controversies when managing both conditions simultaneously.